Provider Demographics
NPI:1982934394
Name:GUNSOLUS, DONNA (LCSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GUNSOLUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VETERANS AFFAIRS
Mailing Address - Street 2:465 NORTH UNION ST.
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1278
Mailing Address - Country:US
Mailing Address - Phone:716-373-7709
Mailing Address - Fax:716-373-8117
Practice Address - Street 1:1 LEO MOSS DR
Practice Address - Street 2:SUITE 4308
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1100
Practice Address - Country:US
Practice Address - Phone:716-373-8040
Practice Address - Fax:716-701-3728
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0819411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635098Medicaid